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Sore throat - acute - Making a diagnosis
Streptococcal infection

  • Streptococcal sore throat [Eykyn, 2003a; Bisno, 2005]:
    • Cannot be diagnosed on clinical features alone.
    • This may cause mild symptoms but it can also cause severe pharyngeal pain, painful swallowing, headache, and a high temperature [Bisno, 2005].
    • Nausea, vomiting, and abdominal pain are common in children.
    • In infants, pharyngitis may be less definite but fever, nasal discharge, enlarged cervical lymph glands, and otitis media occur [Eykyn, 2003a].
    • A patchy grey-yellow exudate is often present on the tonsils and the uvula is often oedematous. The cervical lymph nodes are enlarged and tender [Bisno, 2005].
  • Scarlet fever [Eykyn, 2003a; Bisno, 2005]:
    • Infection with certain strains of streptococci produces the characteristic erythematous rash that fades over a week, followed by desquamation for several weeks.
    • The rash usually appears on the second day of clinical illness and starts as a red blush with many points of deeper red that blanch on pressure. It usually begins on the chest and spreads to the abdomen and extremities and is prominent in skin creases. It has a sandpaper-like texture due to the occlusion of sweat glands. The rash persists for several days, and later (up to 3 weeks) peeling may occur, usually on the tips of the fingers, toes, or ears, and less often over the trunk and limbs.
    • There is an exudative pharyngitis and tonsillitis and there may be small red haemorrhagic spots on the hard and soft palate.
    • The face is flushed, with circumoral pallor.
    • The tongue is initially covered with a yellowish white coat. Through this, the enlarged red papillae (white strawberry tongue) may be seen. Usually, after the rash develops, the coat peels off leaving a raw red papillate surface (raspberry tongue).

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